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Situation: Mom has one leg amputated and solely gets around via wheelchair. She was too stubborn to learn how to use a prosthetic leg. A year and a half later, she now lives in a nursing home. Admin is saying she refuses to wear pants and only has her adult diapers partially pulled up. When staff tries to help her get dressed or adjust her diapers, she gets cross, angry and refuses help. She sits on towels laid out on her wheelchair and on her bed and INSISTS she's clean and happy with the way things are. (I know for a fact, she is sometimes not completely clean.) It's unsanitary and undignified but no one (no family member, no child, no trusted staff) can convince her to wear it. I used to buy her diapers she liked despite the care home offering their own. (She wanted pull-ups. The care home has the kinds with the sticker tabs on the sides. She hates those.) It worked for a while until then she stopped pulling those up completely to cover her bum. Eventually, she asked to have me stop sending them and she'd just use the ones they offer. I don't know how to help her. She stubborn and cranky and seems to be getting worse. I'm considering buying her the ones she likes again if it helps...? Any ideas?

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izzomd, sounds like it could be a sizing issue. My Dad has an issue with not pulling his Depend type products up over his behind, and one of the Aides suggested that I try a larger size.... BINGO, that worked so much better as Dad couldn't stand up by himself for a certain length of time, thus would run out of time to get the garment up where it should be.
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Freqflyer, yes! I thought that too. I used to buy her the size that fit and it worked like a charm. I'll find out if thats the problem or if its an emotional change.
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If Mother is wheelchair bound, does she need help transferring to the toilet? Does she need help getting dressed in the morning? If so, why aren't these people making sure the incontinence garment is fitted properly? So, she gets cross and angry when they assist. It is their job to do it anyway. My mother was docile and cooperative in the nh. She was well-liked by the entire staff. But EVERY time they took her to the bathroom with a sit-to-stand machine, she hollered her head off. She swore. She hurled insults. But the two aides who were assisting went about their job patiently. And when it was over Mom reverted to her sweet pleasant self. I really think the care center needs to be more assertive on this matter. I know they cannot force care she refuses, but they should be doing everything short of using force to make this happen. It's their job.

What does your mother wear? Dresses? Would wearing much longer dresses help? Or loose skirts? They wouldn't tend to ride up as much when she sit.

Many people, men and women, used a lap blanket all the time in my mom's nh. Then it would be easy for an aide to say, "here is your lap cover. It seems a little chilly in the hallways."

There was one woman in my mom's nh who got around well in her wheelchair. She often ate with my mother, but of course then I'd see her from the chest up. I was very surprised to see her in the hall with just a very short dress or tunic, high stockings, and nothing else. This was definitely undignified, but it didn't appear to bother her and she wasn't hurting anyone else. But I hope if I get to that stage someone will prevent me from displaying my private area!

Her hygiene comes first. That could be a real problem for her. Do some brainstorming with the staff to figure out what to try. The undignified apparel is probably more of a problem for you than it is for her right now. But I think it would be a kindness if you could spare her this.

(Is anybody else thinking, "I sure hope I'm not like that when I'm old!")
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I'm with Jeannegibbs, I don't get that the nursing home is allowing this. I'm all for picking your battles when it comes to conflicts, for instance there is a woman in my mom's NH that refuses to wear her cover up (bib) in the dining room and staff have given up on it, but that is at a whole different level than allowing someone who is incontinent to sit semi clothed on a towel. At the very least they could place a tab style brief on the chair below her and do it up after she is seated.

(in addition, there are adaptive open backed pants etc that are designed for wheelchair users, they can be slipped on a seated person and the waist wraps around and snaps at the back)
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Staff probably figures it is easier to remove the towels for cleaning, then to have to "fight" her over pull ups.
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Thanks for the answers everyone. To clarify, yes, Mom can take herself to and from the bathroom. She can balance and pull her diapers up on her own. She is very independent. Sometimes if you offer assistance to pull up her diapers, she'll comply and be grateful. Other times, she'll swat you away saying she doesn't want it and she likes it better w/o it being pulled up.

She does sit on towels and uses a second towel to cover her lap. I've given her many pull-over dresses in pretty floral designs and colors that she likes. Even w/ those on, she'll still put something to cover her lap. Some days, she'll refuse to put a dress on and opt for a medical gown instead. :( On those days, I just grab a dress and put it on her and she won't fight me to wear it. (I learned she hates wearing them because she doesn't want her dresses to get lost in the laundry sorting. She has a hoarding issue and hates her stuff to be out of sight. So she'd rather preserve it than use it.)

Her mood shifts. She was recently documented for having memory issues and lack of capacity for decision making.

At this point, I've learned its a matter of compromise but I talk to her firmly when things start to tip towards unsanitary or unsafe habits.
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Izzomd, is your mom in a nursing home or in assisted living?
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95% of the time, my DH isn't wearing underwear but his shirts do cover whatever hangs out.

This is not just to be more comfortable - but when the needs arise, he has trouble removing the garments and the laundry truly starts to backup on a daily basis. Now I prefer him without briefs but will supply them when asked for. We live alone and rarely if ever get company. He has no incontinence to speak of, just the occasional gas-bubble (sorry if TMI) and I do have waterproof sheets on the couch and his lift-sleep chair. In the 2 years since he was sent home to die from Hospital, we have yet to have him soil the sheets in that manner. I only had to insist on his using the urinal as following him down the hall felt like I was housebreaking a puppy. We still have the occasional puddle but he throws a washrag or a tissue on it so I know it's there and can clean it up. I learned to wear slippers.

He's 96 now and every day we still have together is precious to me. All too soon I will have to let him go and I will miss his smiles.
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Is it possible that the bulk of the briefs or pull ups is uncomfortable under her?
When you are sitting in a wheelchair, not the most comfortable thing by the way, and there is a cushion, then usually an absorbent pad, then the brief or pull up then clothing. That is a lot of bulk and wrinkles to sit on.
I used to cut the back of my Husbands pants out so there was less bulk and fewer wrinkles that might lead to creases on his skin. The back was cut down from about the back part of the hips to right around the lower part of his seat. The pants could be pulled on and off easily the sides of the pants could be tucked behind him to secure the pants. This way it looked like he was wearing pants when you looked at him from the front or side. I also cut the back of his shirts from the bottom to the neck so I could easily slip a clean shirt on without having to move him forward and back., again fewer wrinkles and less skin creases.
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Yes, she probably needs a bigger size.
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As an update, I had a meeting with the SNF staff and we discussed changing her pull-ups size as well as supplying the kind without the sticker tabs on the side. As for her clothing situation, I described to them how I successfully convinced my Mom to get dressed. Usually she'll refuse until you show her a pretty mumu/gown and she'll sometimes agree to wear it.

We even worked out a new shower schedule that works around my mom's "superstitions." (She wouldn't shower on holy days and Fridays for some reason!)
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